Hand And UE Disorders And Injuries Flashcards
Dupuytren’s Disease
Fascia of PALM and DIGITS becomes thick and contracted, developing cords/bands extending to digits
Results in flexion deformities typically 4th and 5th digit; treatment is surgical
Intervention:
- Wound care
- Edema control (elevate above heart)
- Extension splint (if possible, worn at all times except during ROM and bathing)
- AROM/PROM; progress to strengthening when wounds healed
Skier’s Thumb
Rupture of ulnar collateral ligament, usually due to falling while skiing with thumb held in ski pole
Interventions:
A. Conservative tx - thumb splint 4-6 wks
B. AROM & pinch strengthening @ 6wks
C. ADLs requiring opposition and pinch strength
D. Post-op tx inc. thumb splint 6 wks, followed by AROM. PROM can begin at 8 wk & strengthening @ 10 wks
Complex Regional Pain Syndrome
Vasomotor dysfunction as result of an abnormal reflex; can be localized or spread through other parts of extremity
Etiology: May follow trauma (eg colles fracture) or surgery
Sx:
- severe pain
- edema
- discoloration
- sweating
- temp changes
- trophic changes: skin, nail & fingertip appearance
Intervention:
A. Modalities to decrease pain
B. Edema mgmt: elevation, manual edema mobilization, compression glove
C. AROM to involved joints
D. ADLs to encourage pain-free active use
E. Stress loading (wt-bearing & joint distraction activities, incl. scrubbing and carrying)
F. Splinting to prevent contractures and enable engagement in activities
G. Encourage self-mgmt
H. Avoid or proceed w/ caution: PROM, Jt mobilization, dynamic splinting, & casting
Colles’ Fracture vs Smith’s Fracture
Colles’ : Fracture of distal radial w/ dorsal displacement (dinner fork) due to FOOSH
Smith’s : Fracture of distal radial w/ volar displacement
UE Fracture OT Evaluation should include:
A. Occupational profile
B. Hx including mechanism of injury & Fracture mgmt
C. Results of special tests (x-rays, MRI, CT Scan)
D. Edema
E. Pain
F. AROM NO assessing PROM or strength until ordered by PCP
Note: Humerus fracture is exception, often begins w/ PROM or AAROM
G. Sensation (checking for nerve injury)
UE Fracture Interventions: Immobilization Phase
Stabilizing and healing
1) AROM of joints above and below stabilized part
2) Edema control: Elevation manual edema mobilization, gentle retrograde massage, and compression garments
3) Light ADLs and role activities w/ no resistance, progress as tolerated
a) if in sling, immobilized, ORIF etc, instruct in one-handed techniques
UE Fracture Interventions: Mobilization Phase
Consolidation
1) Edema control: elevation, manual edema mobilization, gentle retrograde massage, compression garments
2) Some Pts will require splint for protection
3) AROM (Progress to PROM when approved by PCP, exception of humerus fracture (often begins w/ PROM/AAROM
4) Light, purposeful or occupation-based activities
5) Pain mgmt: positioning and PAMs
6) Strengthening: When approved by PCP
Shoulder fractures most commonly begin with isometric exercises
Cumulative Trauma Disorders
Aka repetitive stress injuries, over-use syndromes, &/or musculoskeletal injuries
Risk factors: repetition, static position, awkward postures, forceful exertions, & vibrations
Non work risk factors: acute trauma, pregnancy, diabetes, arthritis, and wrist size and shape
Most common UE types:
- de Quervain’s
- lateral and medial epicondylitis
- trigger finger
De Quervain’s disease
Inflammation & thickening of sheath containing EPB (ext. poll. Brev.) & APL (Abd. Pol. Long.), resulting in pain on radial side of wrist
Inflammation of tendons = tenosynovitis
Dx’d w/ + Finkelstein
Conservative Tx:
-Thumb Spica Splint (IP joint free)
- Activity/work modification
- Ice massage over radial wrist
- Gentle AROM of wrist & thumb to prevent stiffness
Post-Op Tx:
-Thumb spica splint & gentle AROM (0-2 wks)
- strengthening, ADLs & role activities(2-6 wks)
- unrestricted activity(6 wks)
Lateral vs medial epicondylitis
Lateral = overuse of wrist extensors
Medial = overuse of wrist flexors
Conservative tx:
- elbow strap/wrist splint
- Ice & deep friction massage
- Stretching
- Activity/work modification
- As pain decreases, add strengthening. Isometric-> isotonic and eccentric
Trigger Finger
Aka stenosing tenosynovitis
Problem w/ sliding mechanism of a tendon in its sheath, due to nodule or swelling of sheath or tendon; can no longer slide in and out smoothly
Finger flexes but gets stuck during extension, caused by repetition and use of tools placed too far apart
Conservative Tx:
- Hand or finger-based trigger finger splint (MCP extended, IP joints free)
- Scar massage
- Edema control
- Tendon gliding
- Activity/work modification
Cock-up splint
Wrist in 10-20 deg of ext to prevent contracture
Support flaccid wrist while allowing digit fx
Resting hand splint
Wrist, digit & thumb support in Fx’al position for prolong period (ex developing contracture of long flexors
Opponens splint
Support thumb in position of abduction and opposition
Used during functional activities to compensate for weakness
Rood cone
Inhibitory/ tone normalizing (food’s inhibitory principle of sustained deep pressure)
Cone-shaped splint used to reduce flexor spasticity of hand
